Increased resource utilization and overall morbidity are associated with general versus regional anesthesia for carotid endarterectomy in data collected by the Michigan Surgical Quality Collaborative

Abstract

Based on this analysis from the MSQC database, there is an associated increased morbidity and resource utilization with GA vs RA for CEA. This has implications for enterprise resource planning initiatives and the CEA value proposition in general, which is of special interest to both hospitals and payers.

Association of Primary Anesthesia Type with Postoperative Adverse Events After Transcarotid Artery Revascularization

“…19 In a Michigan Surgical Quality Collaborative registry analysis, Hussain et al evaluated anesthesia type (regional v general) among 4,558 patients who underwent CEA and found extended hospital stay and increased emergency department visits and readmissions in the general anesthesia cohort. 9 The authors did not opine why hospital stay was longer in the general anesthesia cohort. However, the authors did show that readmission rates were greater in the general anesthesia cohorts, and they stated that this may be a result of postoperative neck swelling or a hematoma, differences in the use of heparin, and bucking against the endotracheal tube and associated hypertension.…”

“…3 Other studies in CEA cohorts have shown a mortality benefit in the regional anesthesia group. 9 Even though general anesthesia is safe and effective in this patient population, it is not without risks. First, sympathetic stimulation with endotracheal intubation is concerning in patients with atherosclerosis because this may lead to end-organ ischemia, most notably myocardial ischemia.…”

“…The association of anesthesia type with 30-day adverse events among patients who undergo CEA has been examined, with several studies showing a morbidity and mortality benefit among regional anesthesia cohorts. 3,[9][10][11] However, the literature remains sparse on the influence of MAC on 30-day adverse events after minimally invasive TCAR. Given the unique risks and benefits of TCAR, 5 understanding the association of anesthesia type on outcomes may not only help to decrease periprocedural adverse events through enhanced recovery pathways but also may help to improve a patient's experience and reduce per capita cost of health care.…”

General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

“…Seven nonrandomized studies with one arm's sample size being at least twice as big as the other arm and which had high chances of bias were excluded. 11,12,14,25,27,28,31 The 24 remaining studies were analyzed, yielding similar results: LA was associated with shorter total surgical time (WMD À8.77 min [À16.84 to À0.69]; p = 0.03) ( Supplementary Fig 3), lower stroke rate (OR 0.64 [0.38-0.89]; p = 0.01) ( Supplementary Fig 4), cardiac complications (OR 0.48 [0.32-0.72]; p = 0.004) ( Supplementary Fig 5), 30-day mortality (OR 0.66 [0.45-0.96]; p = 0.03) ( Supplementary Fig 6), and TND rates (OR 0.58 [0.38-0.89]; p = 0.01) ( Supplementary Fig 7). Heterogeneity was significant for total surgical time (I 2 = 0.99, chisquare = 1,214.45; p < 0.00001) and cardiac complications (I 2 = 0.43, chi-square = 29.79; p = 0.03) but not for stroke (I 2 = 0.15, chi-square = 18.88; p = 0.28), TND (I 2 = 0.24, chisquare = 18.33; p = 0.19), and 30-day mortality (I 2 = 0.00, chisquare = 11.72; p = 0.86).…”

“…Several studies have done so, including (but not limited to) those by Liu et al, 12 Schechter et al, 52 Leichtle et al, 53 and the much more recently published analysis by Malik et al 54 Nevertheless, this type of analysis requires a large sample size, and notably, all the aforementioned studies using propensity-matched analysis used data from the American College of Surgeons National Surgical Quality Improvement Program database from different periods (except Liu et al, who also included data from the New York State Inpatient Database). Even though other databases exist, such as the Michigan Surgical Quality Collaborative database, which was used by Hussain et al, 14 there are not enough of them globally for the data to represent populations from different parts of the world. A way forward would be to establish an international registry, much like the International registry of Acute Aortic Dissection.…”